Provider Demographics
NPI:1700164860
Name:SUBUYUJ, ANDREA HELEN
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:HELEN
Last Name:SUBUYUJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4982 WINCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-2027
Mailing Address - Country:US
Mailing Address - Phone:650-207-3594
Mailing Address - Fax:
Practice Address - Street 1:4982 WINCHESTER PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-2027
Practice Address - Country:US
Practice Address - Phone:650-207-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA32332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor